Question about MD-IPA coverage

[Anonymous]

I'm thinking about switching to MD-IPA during open season, but would like to know more about their OB and pediatric coverage (should I be lucky enough to get pregnant!). My OB is not a preferred provider with any insurance company. I currently have BCBS and they were really great about covering most of my OB costs, despite the fact my OB was not a participating provider. Also, my first child was a preemie, so they covered about $100K in NICU costs without any problem. Given my history of pre-term labor, I want to make sure I've got good coverage beyond the fertility treatment benefits and really want to stay with my current OB. Any insights? Thanks!

[Anonymous]

Is this Federal MD IPA? If so, their OB and pediatric coverage is excellent - for OB, I pay one $30 co-pay for all maternity care (also co-pays for the nuchal fold test and 20 week ultrasound) and one hospital co-pay for the delivery (I think it's $100?)

For pediatric care, they cover all well and sick visits to the primary care doctor up to age 13 with no co-pay. (you only pay co-pays for specialist visits for children).

[Anonymous]

Ditto previous poster. My high risk twin pregnancy following IVF (10 hospitalizations, etc) was covered completely for $30.
Well peds visits are free under age 13. Sick visits are $10 or $20.

We've had MDIPA for 7 years and have been very pleased over-all.

[Anonymous]

whoops, previous poster here. Actually, ALL visits for children under 13 are free. NO co-pays.

[Anonymous]

OP here- thanks! Do you know if you can use out of network providers and still get decent coverage?

[Anonymous]

Anonymous wrote:OP here- thanks! Do you know if you can use out of network providers and still get decent coverage?

You do not have any coverage. The whole point of an HMO is that you have to use their providers. Some HMO's have an open access plan (like Aetna) which doesn't require a referral but you still have to use their providers.